One in 3 Americans between the ages of 50 and 64 say they’re embarrassed by the condition of their teeth, according to the latest University of Michigan National Poll on Healthy Aging. A slightly larger group (38 percent) cite pain, difficulty eating, missed work or other health problems in the past two years due to dental problems.

Even though professional cleanings and other preventive care can help thwart dental problems, 40 percent of those polled don’t get such care on a regular basis.

Insurance coverage appears to have a lot to do with this lack of care. Overall, 28 percent of respondents said they don’t have dental coverage. But that percentage was much higher — 56 percent — among those who say they only seek care for serious dental problems.

As for the future, 51 percent of those surveyed said they simply didn’t know how they will get dental insurance coverage after they turn 65. Another 13 percent of middle-aged adults expect to count on Medicare or Medicaid to cover their oral care needs after that age. But traditional Medicare does not cover routine dental care, and Medicaid dental coverage is often limited.

“Our findings highlight a stark divide among middle-aged Americans in terms of their oral health now, and a real uncertainty about how they will get and pay for care as they age,” says associate poll director Erica Solway, Ph.D. “This is not out of disregard for the importance of preventive dental care — more than three-quarters of the people we polled agree that regular care is important to preventing problems later.

“But it does highlight opportunities to improve access to care and insurance options after age 65.”

"Our findings highlight a stark divide among middle-aged Americans in terms of their oral health now, and a real uncertainty about how they will get and pay for care as they age."

Participants answered a wide range of questions online; laptops and internet access were provided to those who needed them.

Solway and poll director Preeti Malani, M.D., a professor of internal medicine at the U-M Medical School, divided the poll respondents into three groups based on their responses about their use of dental care:

Prevention-focused: about 60 percent of the sample, who got regular preventive care as well as getting attention for dental problems

Problem-only: the 23 percent who went to the dentist only for serious dental problems

Classification helped researchers better detail the extent of the problem.

“We know that oral health is a critical factor in overall wellness, and this research helps us identify some key issues — such as affordability and coverage — that we can focus on to address those 40 percent who are not prevention-focused,” stated Alison Bryant, Ph.D., senior vice president of research for AARP.

Uncertain future

Looking ahead to the years beyond their 65th birthday – an age when most Americans become eligible for Medicare — poll respondents were uncertain about how they’d get dental insurance.

Sixteen percent said they would count on employer-based coverage or a retirement-based plan. Another 12 percent said they planned to buy supplemental dental insurance.

And in addition to the half of respondents who indicated that they didn’t know whether they will have dental insurance after age 65, another 8 percent said they would simply go without.

But it’s the remaining respondents, the 13 percent who expect Medicare or Medicaid to cover their dental care in their older years, that pose the bigger concern.

“Traditional Medicare does not cover dental care, and many states offer very limited or no dental coverage for adults with Medicaid,” says Malani. “Even those who were diligent about seeing the dentist and had dental insurance throughout adulthood may find it harder to afford dental care as they get older, and coverage options may be more limited.”

A clear divide

Respondents who were female, white, had higher incomes or had insurance were much more likely than others to take a prevention-focused approach to dental care, the poll found.

Men, African-Americans, Hispanics, those with lower incomes, or those without insurance were more likely to seek dental care for problems only.

Differences among the three groups were also apparent when the U-M team asked about how easy it was to get care and why they might not have sought care.

Among the prevention-focused, only 13 percent said they had delayed or had not received dental care when they needed it in the last two years. But that proportion jumped to 35 percent in the inconsistent-prevention group, and 56 percent in the problem-only group.

Why didn’t poll respondents get needed dental care? Cost was the most common answer, given by 69 percent who said they did not get or delayed needed care.

Respondents also reported they were afraid of the dentist, couldn’t find time to go or couldn’t find a dentist. Of the people who didn’t receive care they needed, 1 in 5 cited fear of the dentist as a major factor.

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